Dexmedetomidine in Cardiac Surgery Patients Who Fail Extubation and Present with a Delirium State

Authors

  • Nihan Yapici
  • Turkan Coruh
  • Tamer Kehlibar
  • Fikri Yapici
  • Arif Tarhan
  • Yesim Can
  • Azmi Ozler
  • Zuhal Aykac

DOI:

https://doi.org/10.1532/HSF98.201011102

Abstract

Background: We evaluated the use of dexmedetomidine to facilitate the weaning of delirious postoperative patients from mechanical ventilation.

Methods: We included 72 consecutive patients who underwent elective cardiac surgery in this prospective observational study. Each patient had failed at least 1 trial of continuous positive airway pressure (CPAP) and had agitation. Patients were assessed with the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAMICU) 12 to 18 hours after their admission to the ICU. Midazolam and fentanyl were then given to all patients according to the sedation protocol. At 36 hours in the ICU, patients who had agitation and an inability to wean were randomly divided into 2 groups: group M, 34 patients who continued to follow the routine sedative protocol; and group D, 38 patients who were given dexmedetomidine. Arterial blood gas measurements, hemodynamic parameters, and time to extubation were recorded. Statistical analysis was performed with GraphPad InStat (version 2.02 for DOS).

Results: All patients tested positive in the CAM-ICU assessment, and all had a delirium diagnosis. The 38 patients in group D tolerated a spontaneous breathing trial with CPAP and were extubated after a mean (±SD) of 49.619 ± 6.96 hours. The 2 groups had significantly different extubation times (58.389 ± 3.958 hours versus 49.619 ± 6.96 hours). The 2 groups had significantly different RASS scores at 48 and 60 hours and significantly different heart rates and PO2 values at 12 and 24 hours. The 2 groups showed no significant differences with regard to hemodynamic parameters.

Conclusions: Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery.

References

Arpino PA, Kalafatas K, Thompson BT. 2008. Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit. J Clin Pharm Ther 33:25-30.nDasta JF, Jacobi J, Sesti AM, McLaughlin TP. 2006. Addition of dexmedetomidine to standard sedation regimens after cardiac surgery: an outcomes analysis. Pharmacotherapy 26:798-805.nEly EW, Inouye SK, Bernard GR, et al. 2001. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703-10.nEly EW, Shintani A, Truman B, et al. 2004. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753-62.nEly EW, Truman B, Shintani A, et al. 2003. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 289:2983-91.nHerr DL, Sum-Ping ST, England M. 2003. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth 17:576-84.nIckeringill M, Shehabi Y, Adamson H, Ruettimann U. 2004. Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: haemodynamic effects and efficacy. Anaesth Intensive Care 32:741-5.nMaldonaldo JR, van der Starre PJ, Wysong A. 2003. Postoperative sedation and the incidence of ICU delirium in cardiac surgery patients [Abstract]. Anesthesiology 99:A465.nMattila MJ, Mattila ME, Olkkola KT, Scheinin H. 1991. Effect of dexmedetomidine and midazolam on human performance and mood. Eur J Clin Pharmacol 41:217-23.nRiker RR, Shehabi Y, Bokesch PM, et al, for the SEDCOM (Safety and Efficacy of Dexmedetomidine Compared with Midazolam) Study Group. 2009. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 301:489-99.nRovasalo A, Tohmo H, Aantaa R, Kettunen E, Palojoki R. 2006. Dexmedetomidine as an adjuvant in the treatment of alcohol withdrawal delirium: a case report. Gen Hosp Psychiatry 28:362-3.nSiobal MS, Kallet RH, Kivett VA, Tang JF. 2006. Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study. Respir Care 51:492-6.nSockalingam S, Parekh N, Bogoch II, et al. 2005. Delirium in the postoperative cardiac patient: a review. J Card Surg 20:560-7.nTruman B, Ely EW. 2003. Monitoring delirium in critically ill patients. Using the confusion assessment method for the intensive care unit. Crit Care Nurse 23:25-36.nvan der Mast RC, van den Broek WW, Fekkes D, Pepplinkhuizen L, Habbema JDF. 2000. Is delirium after cardiac surgery related to plasma amino acids and physical condition? J Neuropsychiatry Clin Neurosci 12:57-63.nVenn RM, Karol MD, Grounds RM. 2002. Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive caret. Br J Anaesth 88:669-75.n

Published

2011-04-26

How to Cite

Yapici, N., Coruh, T., Kehlibar, T., Yapici, F., Tarhan, A., Can, Y., Ozler, A., & Aykac, Z. (2011). Dexmedetomidine in Cardiac Surgery Patients Who Fail Extubation and Present with a Delirium State. The Heart Surgery Forum, 14(2), E93-E98. https://doi.org/10.1532/HSF98.201011102

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